Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China; Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing, Zhejiang Province, China.
Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China.
Clin Breast Cancer. 2023 Oct;23(7):e441-e450. doi: 10.1016/j.clbc.2023.07.004. Epub 2023 Jul 15.
The role of recurrence score in predicting the benefits of adjuvant chemotherapy for lymph-node-positive breast cancer remains uncertain. We studied chemotherapy usage in patients with 1 to 3 positive lymph nodes and a recurrence score (RS) of 25 or lower to assess changes in clinical practice based on the RxPONDER trial.
A retrospective study using the SEER database identified female patients diagnosed with ER-positive, HER2-negative breast cancer, 1 to 3 positive lymph nodes, and an RS of 25 or lower between 2010 and 2015. Patients were divided into nonchemotherapy and chemotherapy groups, with propensity score weighting to balance clinicopathologic factors.
Among 7965 patients, 5774 (72.5%) were in the nonchemotherapy group, while 2191 (27.5%) were in the chemotherapy group. Median follow-up was 39 months. Breast cancer accounted for 67 deaths, while 128 deaths were due to other causes. The weighted 5-year overall survival (OS) rates were 95.7% for the nonchemotherapy group and 97.2% for the chemotherapy group. For high-risk patients, the weighted 5-year OS rates were 95.2% and 97.0% for the nonchemotherapy and chemotherapy groups, respectively, with a significant absolute difference of 1.8% (P = .014). Multivariate analysis showed a significant difference in weighted hazard ratios for OS between the nonchemotherapy and chemotherapy groups in high-risk patients (hazard ratio: 0.64; 95% CI: 0.48-0.86). However, there were no significant differences in weighted hazard ratios for lower-risk patients, and similar results were observed for breast cancer-specific survival (BCSS).
Patients with ER-positive, HER2-negative breast cancer and 1 to 3 positive lymph nodes, assessed by a 21-gene RS of 0 to 25, exhibited heterogeneous prognosis. Adjuvant chemotherapy provided a significant survival benefit, especially for patients with RS of 14 to 25, particularly those with invasive ductal carcinoma (IDC) and 2 to 3 positive lymph nodes.
在预测淋巴结阳性乳腺癌辅助化疗获益方面，复发评分的作用仍不确定。我们研究了 1 至 3 个阳性淋巴结和复发评分（RS）为 25 或更低的患者的化疗使用情况，以评估基于 RxPONDER 试验的临床实践变化。
一项使用 SEER 数据库的回顾性研究，纳入了 2010 年至 2015 年间诊断为 ER 阳性、HER2 阴性乳腺癌、1 至 3 个阳性淋巴结和 RS 为 25 或更低的女性患者。将患者分为非化疗组和化疗组，通过倾向评分加权平衡临床病理因素。
在 7965 例患者中，5774 例（72.5%）为非化疗组，2191 例（27.5%）为化疗组。中位随访时间为 39 个月。乳腺癌导致 67 例死亡，而 128 例死亡归因于其他原因。非化疗组和化疗组的加权 5 年总生存率（OS）分别为 95.7%和 97.2%。对于高危患者，非化疗组和化疗组的加权 5 年 OS 率分别为 95.2%和 97.0%，差异有统计学意义（绝对差异为 1.8%，P =.014）。多变量分析显示，高危患者非化疗组和化疗组的加权 OS 风险比存在显著差异（风险比：0.64；95%置信区间：0.48-0.86）。然而，低危患者的加权风险比没有显著差异，乳腺癌特异性生存（BCSS）也观察到类似结果。
通过 21 基因 RS 评估为 0 至 25 的 ER 阳性、HER2 阴性乳腺癌和 1 至 3 个阳性淋巴结的患者具有异质性预后。辅助化疗提供了显著的生存获益，特别是对于 RS 为 14 至 25 的患者，尤其是那些患有浸润性导管癌（IDC）和 2 至 3 个阳性淋巴结的患者。
